- CoxHealth (Lake Spring, MO)
- …to include severity of illness, risk and resource utilization through correct MS/APR DRG assignment and CC/MCC captures. Will be responsible with working with CDI ... the following Committees: 1) Coding and Documentation Committee 2) Utilization Review Committee 3)SOI Scorecard Committee 4) Educational sessions for Providers as… more
- Stanford Health Care (Palo Alto, CA)
- …coding with ICD, HCPCS, CPT codes, as well as APC and DRG assignments, while identifying instances of overpayments and underpayments. Proficiency in healthcare ... claims analysis, including the ability to review , interpret, and evaluate claims data to identify trends,...successful outcomes. + Knowledge of medical and insurance terminology, MS- DRG , APR- DRG , CPT, ICD coding structures, and… more
- Stanford Health Care (Palo Alto, CA)
- …scoring methodology to consistently evaluate coding accuracy and standardizes review findings and methodology to report monitoring results. Communicates ... review results to department management, coders and other appropriate...CPT (Current Procedural Terminology) codes; evaluates the appropriateness of DRG (Diagnosis-related Group) and admission assignments; evaluates appropriateness of… more
- Premera Blue Cross (Mountlake Terrace, WA)
- …and compliance with contractual, coding, payment policy, and regulatory standards. + Review itemized bills, medical records, and other claim documentation to verify ... + Validate coding accuracy for CPT, HCPCS, ICD-10-CM, and DRG . + Identify and report coding discrepancies or errors...Abilities** + Basic understanding of CPT, HCPCS, ICD-10-CM, and DRG coding. + Strong attention to detail and analytical… more
- Stony Brook University (Stony Brook, NY)
- …to the Bone Marrow Transplant service. + Ensure procurement charges are coded into DRG . + Record keeping for the purchase and procurement of stem cell, bone marrow, ... cord blood, immune effector cells, and HLA typing. + Review charges with BMT Program Manager and manage care...or for a maximum of 90 days. An initial review of all applicants will occur two weeks from… more
- Lyric (Newtown Square, PA)
- …to processing medical insurance claim overpayments through recovery (40%) + Review claims for missing or incomplete information, calculate payment, or validation ... well as an understanding of medical terminology, and prospective payment systems including DRG , OPPS, and MIPS + Creative thinker with an entrepreneurial spirit +… more
- Zelis (FL)
- …personal interests that shape who you are. Position Overview The Inpatient DRG Reviewer will be primarily responsible for conducting post-service, pre-payment ... and post pay comprehensive inpatient DRG reviews based on industry standard inpatient coding guidelines...Clinic and client specific coverage policies. Conduct prompt claim review to support internal inventory management to achieve greatest… more
- Zelis (NJ)
- …is responsible for conducting post-service, pre-payment and post pay comprehensive inpatient DRG Quality Assurance reviews in an effort to increase the savings ... achieved for Zelis clients. Conduct reviews on inpatient DRG claims as they compare with medical records utilizing ICD-10 Official Coding Guidelines, AHA Coding… more
- Centene Corporation (Helena, MT)
- …including a fresh perspective on workplace flexibility. POSITION IS REMOTE CANDIDATE WILL REVIEW INPATIENT DRG 'S IDEAL CANDIDATE WILL HAVE DRG CODING ... EXPERIENCE **Position Purpose:** Perform clinical/coding medical claim review to ensure compliance with coding practices through a comprehensive review and… more
- HCA Healthcare (Overland Park, KS)
- …want to join an organization that invests in you as a Coding Quality Audit Reviewer ? At Parallon, you come first. HCA Healthcare has committed up to $300 million in ... work from home!** **Schedule: Monday-Friday Day Shift** **Must have DRG Validation experience and Inpatient Coding experience** **Benefits** Parallon,...We are looking for a dedicated Coding Quality Audit Reviewer like you to be a part of our… more
- UPMC (Pittsburgh, PA)
- …monitored and evaluated and procedures that were performed during an episode of care. + Review and evaluate focused UPMC DRG medical records for accurate DRG ... UPMC Corporate Revenue Cycle is hiring a DRG Specialist to work on inpatient auditing within...hours Monday through Friday. In this role, you will review clinical documentation within the medical record to ensure… more
- Molina Healthcare (Caldwell, ID)
- …clinical nursing experience in claims auditing, quality assurance, recovery auditing, DRG /clinical validation, utilization review and/or medical claims review ... JOB DESCRIPTION Job Summary The RN Lead, DRG Coding/Validation provides lead level support developing diagnosis-related group ( DRG ) validation tools and process… more
- Excellus BlueCross BlueShield (Rochester, NY)
- Job Description: Summary: The Payment Integrity DRG Coding & Clinical Validation Analyst position has an extensive background in acute facility-based clinical ... has a high level of understanding of the current MS- DRG , and APR- DRG payment systems. This position...and claims processing platform. . Manages case volumes and review /audit schedules, prioritizing case load as assigned by Management.… more
- Elevance Health (Atlanta, GA)
- …clinical documentation supports the conditions and DRGs billed and reimbursed. Specializes in review of Diagnosis Related Group ( DRG ) paid claims. **How you will ... **Diagnosis Related Group Clinical Validation Auditor-RN (CDI, MS- DRG , AP- DRG and APR- DRG )** **Virtual:** This role enables associates to work virtually… more
- Emory Healthcare/Emory University (Atlanta, GA)
- …to educate physicians, nursing, and other clinical staff to improve documentation. + Review ?s DRG Reassignment letters and assists in formulating Appeal letters ... leadership programs and more! **Description** We are seeking an experienced **Inpatient DRG Coding Auditor** to extract data from patient encounters ensuring the… more
- Elevance Health (Hanover, MD)
- …clinical reviews of medical records and other documentation to evaluate issues of coding and DRG assignment accuracy. Specializes in review of DRG coding via ... ** DRG CODING AUDITOR** **_Virtual_** **_: _** _ _...to recover, eliminate and prevent unnecessary medical-expense spending. The ** DRG CODING AUDITOR** is responsible for auditing inpatient medical… more
- Insight Global (South Jordan, UT)
- Job Description Insight Global is seeking a DRG Validation Auditor for one of our clients to sit 100% remote. This person should have an extensive background in ... a high level of understanding of reimbursement guidelines specifically an understanding of the MS- DRG , AP- DRG , and APR- DRG payment systems. This position is… more
- HCA Healthcare (Nashville, TN)
- …personal growth, we encourage you to apply for our Coding Quality Audit Reviewer opening. We promptly review all applications. Highly qualified candidates will ... We care like family! Jump-start your career as a DRG Validation Auditor today with Parallon. **This position is...result in appropriate reimbursement and data integrity. You will review outcomes are communicated to the HSC team to… more
- Kaleida Health (Buffalo, NY)
- …and insurance / managed care practices including but not limited to: utilization review , RAC, MAC, Q10, clinical and DRG denial management required. **Working ... **Director Clinical and DRG Denials** **Location:** Larkin Bldg @ Exchange Street...Shift 1 Job Description **Summary:** The Director, Clinical & DRG Denials provides clinical leadership and administrative guidance to… more
- Community Health Systems (Franklin, TN)
- **Job Summary** The DRG Denials Auditor conducts hospital inpatient DRG denial audits for both RAC and non-RAC accounts, reviewing patient records for accuracy ... in ICD-10-CM/PCS coding, DRG assignments, and supporting clinical documentation. This includes evaluating...via scanned, electronic and hybrid medical records. Based on review findings, writes appeal letters to include supporting documentation.… more
